What might the future hold for improvement?

The turn of the year is a natural point to look ahead. In Q, we’re taking some time to look beyond 2019, to think about how the world of improvement might be different by 2025 or 2030. This blog shares some early thoughts on possible trends: hopefully useful when you’re thinking about your own work and professional future. We’re hoping this will provoke challenge, questions and additional ideas that we can use to inform future plans for Q.

As you’ll see from the comments below and debate on twitter, the blog has already prompted some good discussion about the importance of co-production as a key future theme in improvement – a discussion which we hope there will be opportunity to explore further in 2019.

Why now?

We’re doing this because we’re in the process of developing proposals for Q beyond the initial funding period, which runs to April 2020. Q was set up with an ambition that it would be here for the long-term. As part of our future strategy, we need to understand how the world within which Q lives may change so that we can ensure Q develops to stay relevant for members and the health system.

Initial conversations with leaders from Q’s partner organisations in each country in the UK identified 6 high level ways in which the world of improvement appears to be evolving.

The Health Foundation is embarking on wider work on approaches to foresight and we’re learning this is not about trying to predict the future – instead it’s about exploring trends to help stretch thinking about how your work might need to adapt to thrive in different potential scenarios.

Having reviewed a set of global trends, initial conversations with leaders from Q’s partner organisations in each country in the UK identified 6 high level ways in which the world of improvement appears to be evolving.

Expanding change ambitions

The task lists of improvers are increasingly likely to consist of work that is inherently cross-boundary and systemic in nature. From redesigning care pathways and improving health in communities, to integrating health and social care, the level of ambition for improvement has been expanding for some time and that seems set to continue. The widespread interest in IHI’s triple (or quadrupal) aim suggests this is global. Improvers are needing to develop new connections and methods to tackle these bigger challenges. And in this new world, being able to work effectively across professional and organisational boundaries is likely to be just as important to success as any specific improvement methods. We think that means the skills and links people build through Q will feel increasingly valuable.

Ongoing need for incremental quality improvement

This trend to larger scale ambitions is not to say that incremental improvement in service quality at the point of care will no longer be important. With little sign that the pressures on public services will abate over the years ahead, it sadly seems likely we’ll see further crises, calling for action on specific aspects of safety, service user experience and perhaps increasingly equity. Organisations will need to manage a portfolio of activity, with appropriate capacity and skills matched to iterative service development and more transformational service change – the latter of course needs to be underpinned by ongoing iterative redesign as new care models get into the detail.

Technological innovation

There seems set to be growing attention paid to introducing new technologies. Making the most of technological and information advances requires process change and often role redesign and different model of working with service users. Might Q help bring together the people with the skills and experience in these different fields?

As technological change will come both through incremental improvement by current providers and disruptive innovation, NHS providers may need to be able to navigate choppier waters in the years ahead. Could Q be a place that increasingly bridges the (sometimes imaginary?) divide between the ‘innovation’ and ‘improvement’ camps, so we can make the most of the methods and instincts of both.

Demand for scale

The evolving improvement agenda will be set against a financial reality that is likely to continue to be tough for many years ahead.The recognition of the size and urgency of the financial and other challenges facing health and other public services is likely to fuel increased pressure to secure adoption of new practices on a larger scale more quickly than has been achieved to date. In parallel of course, we’re learning how complex the process of adoption can be. As we look ahead, we’ll be asking what more could be done to develop Q as a flexible conduit for organic and more purposeful adoption of new ideas and practices. Q Lab can play an important role in understanding how we tackle shared challenges in a collaborative way to lay the ground for wider uptake.

Funding for improvement

The evolving improvement agenda will be set against a financial reality that is likely to continue to be tough for many years ahead.

We anticipate there will continue to be investment in structured approaches to making health and care better and responsibility is likely to continue to be distributed across multiple organisations. When thinking about the future, anticipating regular restructuring of these organisations is sadly one of the safer bets. The hope is that Q will make it easier to sustain the human connections between those involved in improving care, whatever fluctuations continue in the organisations around us.

Financial constraints

The financial pressures on the health and care sector are set expected to continue to be significant, notwithstanding additional funding for the NHS in England accompanying the long-term plan. This influences the work plan and environment for many of those involved in improvement. Financial constraints should mean what Q offers in terms of pooling resources and making the most of existing knowledge and skills is increasingly recognised as business critical. Yet, however strong the strategic case, people being able to take a few hours away from operational priorities is likely to continue to be hard. In this context, Q needs to ensure the relevance and flexibility of what’s available to members and that we’re helping members describe the value of participation to their employers.

Share your thoughts

What do you think? Are these the key things that you see ahead? What are we missing? This is pretty much today’s agenda rolled forward, yet a key idea from the world of foresight is that major priorities are first felt as ‘weak signals’ from the margins of current activity. What are the things you’re noticing that you think could be rising priorities, worthy of greater attention now? Please share your thoughts as comments in response to this blog, or feel free to blog in reply.

Your thoughts will be fed into the work to shape Q for the future. And hopefully the insights we share will help us all be better equipped to prepare for what lies ahead.

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Comments

What ever path is taken over the next five years by policy and operational leaders,from my perspective as a representative of patients ,carers and service users, it must be underpinned by by a much more meaningful engagement process ,that shares involvement in decision making, that listens and acts on patient experience and knowledge. Bottom up not top down ! Peter Pinfield Healthwatch Worcestershire

I agree with Peter's comments, but I feel that PPI is making is making inroads into Secondary Care and Research projects. Where iwould like to see the major change is in decision making in Primary Care. At the moment involvment at decision making leavels seems to be in its infancy.
Marilyn Foster Lay Fellow Improvement Academy. West Yorkshire

Thanks Peter - a point well made. And not just because co-production is the right way to go, but because the sorts of service shifts needed in the years ahead would seem to require much deeper engagement than we've seen to date.
I often wonder what is needed to enable the move to more profound leadership of service change with patients and the public that you describe? We've been talking about it for a while... What will make 2025 different?
I'm excited by the number of patient leaders that are now joining Q and wondering what that might allow in terms of pushing forward on this stuff?

Thought provoking blog Penny - thanks. I think for me another theme growing in importance is evidencing the impact of quality improvement, particularly related to key priorities (national/ system and place based -STP,ICS etc/ local – care providers across all sectors/ micro-system – directorate/service/team.

Great point Karen. And as we tackle change on a larger scale, across systems, evidencing and attributing impact becomes even harder perhaps?
THIS institute and the Improvement Analytics Unit are part of trying to develop approaches to understanding the impact of improvement activities in a way that is both rigorous and reflects the complexity of real-world change efforts.

People have indicated about PPI and coproduction here as critical in the above. We also need a rigorous evaluative framework of the kind of embedded participation models in improvement that achieve person and health outcomes and result in sustained impacts in the healthcare system. If we think about coproduction's two main origins 1) service use consumption creates value and so we are co-producers in healthcare 2) and a coproduction approach should result in power transfer, then, an evaluative framework to identiy value and power transfer is critical to this task.
Victoria Palmer, Associate Professor, Integrated Mental Health Research Program, The University of Melbourne, Australia.

Hi Victoria - thanks a lot for this. Holding to the principles of co-production is needed to move beyond the relatively superficial PPI activity that is often seen in the health service to a deeper approach to redesigning care. The first Q Lab project on scaling peer support services brought home to me the challenges with trying to introduce services starting with a holistic view of what matters to people into / alongside the current medically-focused health system.
Are there good examples of evaluation of value and power transfer that you can share? There are many this side of the globe in the Q Community who I suspect would be very interested.

Good to hear your thoughts, Penny, I particularly like the suggestion of bringing improvement and innovation closer together. Listening to people outside our traditional structures and to those who use our services should challenge us to be brave, try something really new and test out the impact from a range of perspectives.
We must use the workforce challenges we currently face in Health and Social Care to push us in this direction, creating & supporting people in new roles which, whilst challenging to traditional professional identities and ways of working, also provide opportunities to adapt our offer to more holistic and less heirarchical and siloed services.

Hi Helen, I'm glad that struck a cord. I can't work out how optimistic to be on the role redesign front. A burning platform of sometimes undoable jobs and fragmented services can lead to fresh thinking about roles. But sometimes also leads to retrenching to trying to protect professional identity. How far do you think we can believe the next generation will bring less siloed instincts in their approach to work? How can we ensure younger professionals are able to work in a more collaborative, flexible way, even as seniority brings more organisational responsibilities? Sometimes the invisible walls between different tribes in the improvement and innovation world makes me wonder how far we're really going to be able to support cross-boundary working elsewhere in the workforce!

Our community manager Matthew Mezey is setting up a video chat in the new year between the Q member leading on NHS Always Events co-production and the members leading the Learning from Excellence movement. The call will look at whether patient LfE feedback could be used to initiate new Always Event co-production. It would be great to see anyone interested in this on the call - keep an eye on the Upcoming Events page.